VA Form 26-4555c
Application for Home Improvements and Structural Alterations (HISA) Grant
You need a medically required home modification (wheelchair ramp, grab bars, accessible bathroom) and either don't qualify for SAH/SHA or need a smaller modification.
- Who fills it
- veteran
- Journey phase
- Specialty Benefits
- Estimated time
- 20-30 minutes.
- When to file
- After getting a physician's prescription for the modification and before starting construction.
Official VA form page: https://www.benefits.va.gov/homeloans/adaptedhousing.asp
Walk it box by box
Fill it out with your information
Open the official VA form, then work down the boxes below. Each one is pre-filled from what you have already entered in Claim Recon and explained in plain language with the wording a VA rater expects. Review and edit every answer, then export your worksheet and copy it onto the official form. We never fill out or submit anything for you.
Gather before you start
- ▸Physician's written prescription specifying the medically required modification
- ▸Contractor estimate for the modification
- ▸Property ownership documentation (own the home)
- ▸VA enrollment information (must be receiving VA health care)
Attach with the form
- ▸Physician's prescription or prescription letter
- ▸Contractor estimate with itemized costs
- ▸Proof of home ownership
Section I - Veteran Identification
Blocks 1-5Name, SSN, VA File Number, addressPII
Your identifying information. HISA is applied through the prosthetics/rehabilitation department at your VA medical center, not through VA Regional Loan Centers. Contact your VAMC first.
(legal name, SSN, VAMC information)
Common mistakes
- ×Contacting the VA loan center about HISA - it is a health care benefit processed through your VAMC prosthetics department, not the loan program.
- ×Not knowing HISA is available for non-SC conditions too - wider eligibility than SAH/SHA.
Section II - Medical Necessity Documentation
Blocks 6-10Physician prescription for the modification and description
Your VA (or VA-approved) physician must write a prescription specifying the medically necessary modification. The prescription must describe: (1) The specific modification needed, (2) The medical reason (which condition requires it), (3) How the modification supports your medical treatment. Examples: wheelchair ramp prescribed for SC spinal cord injury; roll-in shower prescribed for non-SC Parkinson's disease.
e.g., Dr. Smith, VA VAMC Phoenix, prescribed: "Bathroom modifications including roll-in shower and grab bars for patient with bilateral lower extremity weakness (SC condition) to allow safe bathing without caregiver assistance."
Common mistakes
- ×Ordering modifications before getting VA approval - VA must inspect and approve before payment.
- ×Vague physician prescription - must specify the exact modification and the medical reason.
- ×Not knowing both SC and non-SC conditions qualify, but with different grant limits.
Authority
- 38 USC 1710 - Core VA health care eligibility.
Section III - Modification Details and Estimate
Blocks 11-16Specific modifications, estimated cost, and contractor
Describe each modification being requested and attach an itemized contractor estimate. HISA covers medically required structural modifications - not cosmetic improvements.
e.g., Roll-in shower installation: $3,200; grab bars (4): $600; threshold ramp: $800. Total: $4,600. Contractor: ABC Home Modifications.
Common mistakes
- ×Including cosmetic or non-medically-required improvements in the estimate - HISA only covers what the prescription specifies.
- ×Not getting multiple estimates - VA may request a second estimate if the first seems excessive.
Section IV - Certification
Blocks 17-18Veteran signature and datePII
Sign and date. Submit to your VAMC prosthetics department for processing.
(signature/date)
Common mistakes
- ×Mailing to VA Regional Loan Center - HISA goes to the VAMC prosthetics department.
Statutory and regulatory authority
- 38 USC 1710 - Core VA health care eligibility.